neuro eval lecture 8

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neuro eval lecture 8
2012-10-28 16:17:21
neuro eval lecture

neuro eval lecture 8
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  1. jobs of the cerebellum
    • coordinated activity - fluid movement and postures
    • comparison of motor activities (did the movement match the pre-movement plan?)
    • modification of motor output based on sensory input and prior motor output
    • compensation for motor tasks
    • predictive/anticipatory mvmnts - to get body read for mvmnt -like bracing when you see someone running towards you
    • learning new motor programs
  2. how to eval a loss of anticipatory balance skills
    • have pt stand eyes closed feet together
    • someone who's impaired will sway, and won't catch himself until he's falling - he won't react to the loss of balance until it's too late to do a simple adjustment
  3. one reason recovery frm a cerebellar injury is extra tough
    the cerebellum plays a big role in learning...
  4. vestibulocerebellum aka archicerebelum - lesions --> ?   - receives input from and outflow to __
    • lesions --> inability to utilize vestibular inputs - therefore an inability to adjust to those inputs...
    • vestibular nuclei
  5. spinocerebellum/paleocerebellum - gets input from where? what is it in charge of?
    • input from spinocerebellar tracts
    • movement completion and muscle tone (this tone regulation is unrel to spasticty -it's about support muscle tone - like tightening your core as you pick up a heavy box - w/cerebellar lesions force becomes erratic -- pushing a button you'll vacillate between lots and little pressure)
  6. cerebrocerebellum (neocerebellum) - where is it, input from where, output to where?
    • lateral cerebellar hemispheres
    • input from pontine nuclei
    • output to thalamus, motor and premotor cortex
  7. cerebrocerebellum/neocerebellum controls what?
    • control of rapid movement
    • precise movement control
    • motor planning
  8. lesions where cause dysmetria and disdiadochokinesia
    cerebrocerebellum / neocerebellum
  9. dysmetria
    • (due to lesion in the cerebrocerebellum/neocerebellum)
    • inability to accurately jude the speed, force, or distance needed for a task
  10. asynergia/dysynergia
    movement decomposition - lack of movement fluidity
  11. 8 signs of cerebellar dysfunction
    • dysmetria
    • asynergia/dysynergia
    • rebound phenomena
    • tremor
    • hypotonia
    • ataxic gait
    • cerebellar speecy - dysarthria
    • nystagmus and impaired extraocular movements
  12. rebound phenomenon
    • "lack of check"
    • pt flexes arm to 90 and tries to keep it here while PT tries to push it down
    • when PT suddenly releases arm should go up just once - if there's a lesion it'll bounce up and down and up and down
  13. cerebellar speech
    due to loss of control over diaphram, this speech will sporadically change in volume and intensity
  14. test for dysmetria
    • finger-nose-finger at diff ranges, speeds, location
    • heel-shin test

    don't mistake weakness, spasticity, sensory loss for dysmetria!
  15. disdiadochokinesia
    difficulty w 2 alternating movements / impaired ability to perform rapid, alternating movements in hands or feet

    don't mistake weakness, spasticity, contraction, or sensation troubles for a pos dis sign
  16. components of mvmnt that can be messed up in disdiadochokinesia
    • lengthening/shortening
    • force
    • timing
    • speeds
  17. test for disdiadochokinesia
    • flip flop hands on thighs
    • tap toes heels toes heels on floor
  18. nice thing regarding cerbellar damage
    the cerebelum is densly packed, so there's a good probability of neuroplasticity
  19. titubation
    • cerebellar issues of the neck
    • fyi - can have cerebellar findings for jut one area - eyes, neck, etc